Application

 

SF CIty Seal
Board of Supervisors
City and County of San Francisco
1 Dr. Carlton B. Goodlett Place, Room 244
San Francisco, California 94102-4689
(415) 554-5184 FAX (415) 554-5163

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Application For Boards, Commissions and Committees

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Application for Appointment to: ________________________________________________________________

Name of Board, Commission, Committee, or Task Force

Seat # or Category (If Applicable): ______________________________________________________________

Print Name ______________________________________________________________________________

Home Address _______________________________________________________ Zip _________________

Home Phone: ______________________ Occupation: _____________________________________________

Work Phone: ______________________ Employer: ______________________________________________

E-Mail Address: __________________________Fax #___________________ Pager #____________________

Business Address ___________________________________________________ Zip ____________________

Are you a United States citizen, or a resident alien who is eligible for and has applied for citizenship? Yes No

Have you ever been convicted of a felony in this state, or convicted of any offense which, if committed in this state, would be a felony?

Yes No. (If yes, please attach a statement describing the offense(s) for which you have been convicted, the date of those conviction(s), and the court(s) that convicted you.)

Education _________________________________________________________________________________

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Business and/or professional experience ________________________________________________________

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Civic Activities _____________________________________________________________________________

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Other Personal Information: (optional) ___________________________________________________________

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Ethnicity: (optional) ________________________ Sex: (optional) M F

Have you attended any meetings of the Board/Commission to which you wish appointment? Yes No

Would you be able to attend night meetings? ____ Day meetings? ____ Either ___________

Please state your qualifications (attach supplemental sheet if necessary)____________________________________________________

Is this a Supervisorial appointment? Yes No If yes, Name of Supervisor _______________________________________

For a Supervisorial appointment, no appearance before a Board committee is required, pursuant to Ordinance Number 41-00.

 

For a Board of Supervisors appointment, appearance before the RULES COMMITTEE is a requirement before any appointment can be made. (Applications must be received 10 days before the scheduled hearing.)

Date ____________________ Applicant"s Signature ___________________________________________

Please Note: Your application will be retained for one year.

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For Office Use Only: Appointed to Seat #:_______ Term Expires:____________ District #:_______